Effect of Multicomponent Exercise on Cognition, Physical Function and Activities of Daily Life in Older Adults With Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-analysis

Effectiveness of virtual reality interventions on quality of life, cognitive function and physical function in older people with Alzheimer's disease: A systematic review

This systematic review aimed to evaluate and synthesize the scientific evidence of virtual reality (VR) interventions on quality of life, cognitive function, and physical function in older people with Alzheimer's disease (AD). A systematic review search until March 2025 using seven generic databases: PubMed, EBSCOhost, CINAHL Complete, Cochrane, ProQuest, Scopus, and Web of Science. The PRISMA, RoB 2, and GRADEpro tools were used to assess the methodological quality, risk of bias, and certainty of the evidence.The protocol was registered in PROSPERO database, CRD42024629853. Of 3347 records identified across the databases, seven studies were analyzed using the PICOS format. This review included 517 older people with AD (mean age 76.5 years; 57.5 % female). Due to the heterogeneity of the assessment tools, a meta-analysis could not be performed. Although no consistent significant differences were found between the experimental and control groups, several individual studies reported improvements. Specifically, two studies showed improvements in quality of life and cognitive function, while three reported enhancements in physical function. The interventions included immersive cognitive training, exergaming, Kinect-based systems, and Physiomat platforms, with durations ranging from 4 to 16 weeks and frequencies of 2-5 sessions per week. Analysis of the reviewed studies suggests that VR interventions may benefit cognitive function, physical function, and, to a lesser extent, quality of life in older people with AD.

Effects of Exercise Intervention on Functional Mobility among Older Adults with Cognitive Impairment: A Quantitative Evidence

OBJECTIVES

This meta-analysis aimed to assess the effect of exercise interventions on functional mobility among older adults with cognitive impairments such as dementia or mild cognitive impairment, followed by further investigation on the possible moderators of exercise-induced effects on this outcome.

DESIGN

A meta-analysis of controlled trials on exercise interventions reporting functional mobility outcomes was conducted. PubMed, Embase, EBSCO, SPORTDiscus, and Web of Science were searched for relevant studies published in English-language journals through July 2024.

SETTING AND PARTICIPANTS

Clinical and community settings across 15 countries, including a total of 1104 older adults with cognitive impairment, were involved in the study.

METHODS

We computed pooled effect sizes based on standardized mean difference (SMD) using the random-effects models. The subgroup analyses and meta-regression were conducted for multiple moderating variables (eg, exercise, sample, and study characteristics). The study quality was evaluated using the Physiotherapy Evidence Database Scale.

RESULTS

This meta-analysis finally included 22 studies. Results revealed that exercise interventions effectively improved functional mobility as compared with that of the control group (SMD, -0.42; 95% CI, -0.61 to -0.24; P < .001). Exercise intervention characteristics (ie, weekly training frequency and session duration) and sample characteristic (ie, percentage of women) moderated the exercise-induced effects on this interesting outcome. Subgroup analyses showed intervention with low frequency (1-2 times/wk) (SMD, -0.71; 95% CI, -1.01 to -0.42; P < .001) had a larger improvement in mobility, followed by medium frequency (SMD, -0.33; 95% CI, -0.56 to -0.10; P < .01). In addition, interventions with a session duration of > 60 minutes (SMD, -0.60; 95% CI, -0.84 to -0.36; P < .001) and 45 to 60 minutes (SMD, -0.60; 95% CI, -0.91 to -0.29; P < .001) had a significant improvement in mobility. Moreover, exercise training had a significant improvement in mobility for studies with a high percentage of women (SMD, -0.49; 95% CI, -0.67 to -0.31; P < .001).

CONCLUSIONS AND IMPLICATIONS

Exercise intervention is a promising way to improve functional mobility among older adults with cognitive impairment. Further evidence suggests that larger effects were observed in exercise intervention features of more than 45-minute session duration 1 to 3 times a week for at least 6 weeks regardless of exercise type. In addition, women benefit more from exercise interventions than men. Our study highlights that health care providers should prioritize integrating structured exercise programs into routine care for this population.

Association between physical activity levels and mild cognitive impairment in Chinese older adults: a cross-sectional study from the China health and retirement longitudinal study

Background

Research indicates that mild cognitive impairment (MCI) in older adults is linked to physical activity; however, the relationship between varying levels of physical activity (PAL) and the risk of MCI needs further exploration.

Objective

This study explores the association and dose-response relationship between different levels of physical activity and MCI in older adults.

Methods

Using data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 5,373 older adults aged 60 and above. Binary logistic regression models and restricted cubic spline (RCS) methods were employed to examine the association and dose-response relationship between different PAL levels and the risk of MCI in the overall population and subgroups. Sensitivity analyses were conducted to validate the robustness of the results.

Results

In the overall study population, compared to the lowest PAL quartile, participants in the second PAL quartile had a significantly reduced risk of MCI by 21.3% (p < 0.05). Given that the second PAL quartile had the lowest risk of MCI, a logistic regression model was constructed using the second quartile as the reference group. The results showed that, compared to the second PAL quartile, participants in the first and fourth PAL quartiles had significantly increased risks of MCI by 27.1% (p < 0.05) and 38.2% (p < 0.05), respectively. In subgroup analyses, compared to the second PAL quartile, female participants in the third and fourth PAL quartiles had significantly increased risks of MCI by 50.1% (p < 0.05) and 89.0% (p < 0.05), respectively; participants aged 60-74 in the first and fourth PAL quartiles had significantly increased risks of MCI by 29.4% (p < 0.05) and 42.2% (p < 0.05), respectively; and rural residents in the fourth PAL quartile had a significantly increased risk of MCI by 33.5% (p < 0.05). In the Chinese older adult population, a dose-response relationship was observed between physical activity and the risk of MCI. The RCS curve showed that as physical activity increased, the risk of MCI gradually decreased, reaching a beneficial point at 900 MET-min/week, with the lowest risk at approximately 1,600 MET-min/week. Beyond 1,600 MET-min/week, the risk of MCI began to rise, reaching a significant increase at 2,100 MET-min/week. Sensitivity analyses confirmed the robustness of the findings.

Conclusion

Physical activity levels between 900 and 2,100 MET-min/week are associated with a reduced risk of MCI in the Chinese older adult population. Using physical activity to predict the risk of MCI in this population is feasible, and moderate physical activity may be an effective strategy for preventing and managing MCI.

Effects of Implementing 15-Minute Physical Exercise Sessions During Physical Education Classes on Physical Fitness and Anthropometric Indicators in Rural Adolescents

BACKGROUND

The prevalence of overweight, obesity, and low physical fitness is associated with minimal engagement in physical exercise (PEx) and has increasingly affected children and adolescents in rural areas. This study examines the effects of a 15-minute PEx intervention on the levels of physical fitness and anthropometric indicators of overweight and obesity among rural school students.

METHODS

A total of 245 school students (135 boys and 110 girls), aged between 11 and 17 years, were randomly allocated into intervention and comparator groups. The intervention lasted for 12 weeks, comprising 24 PEx sessions. Physical fitness was measured through cardiorespiratory fitness, muscular strength/endurance, handgrip strength, lower limb power, flexibility, speed, and agility. The measured anthropometric indicators of overweight and obesity included body mass index, waist circumference, and the sum of subscapular and triceps skinfolds.

RESULTS

Generalized estimating equations analysis, performed with an intention-to-treat approach, indicated significant group × time interaction (P < .05) for flexibility, muscular strength/endurance, handgrip strength, cardiorespiratory fitness (only for boys), and waist circumference. For these 5 variables, there were no differences between groups at the baseline (P > .05), and the intervention group showed significantly greater improvements compared with the comparator group at the postintervention time (P < .05).

CONCLUSION

An intervention program consisting of 15 minutes of PEx during PE classes, conducted twice a week for 12 weeks, improves cardiorespiratory fitness, flexibility (only for boys), muscular strength/endurance, handgrip strength, body mass index (only for girls), and waist circumference of rural adolescent school students.

Use of multicomponent structured exercise to improve depression in older adults: A systematic review and meta-analysis

Objective

To summarize the characteristics, estimate the efficacy of multicomponent structured exercise (MSE) intervention on older adults' depression, and investigate its potential moderators.

Methods

MEDLINE, PubMed, PsycINFO, SPORTDiscus, Web of Science and Embase databases were searched from January 1, 2000 to June 1, 2024. Randomized controlled trials (RCTs) that included MSE intervention with aerobic, resistance and balance components targeting older adults, and reported depression as an outcome were selected. Random-effects meta-analyses were used to calculate effect sizes from the standardized mean difference (SMD) and 95 % confidence intervals (CIs). Meta-regression was conducted to identify the potential moderators.

Results

Data were extracted from 19 studies (22 comparisons) with 1763 older adults. MSE showed a significant intervention effect on buffering older adults' depression (SMD, -0.49; 95 % CI, -0.84 to -0.14) but with considerable heterogeneity (I2 = 92 %) and low certainty of evidence. In subgroup analyses, MSE with unhealthy status participants, intervention duration of 12-24 weeks, over 2 times/week intervention frequency, equipment used and ≥ 80 % retention rate showed significant effects on improvement of older adults' depression. Intervention frequency (β, -0.83; 95 % CI, -1.50 to -0.16) and retention rate (β, 0.80; 95 % CI, 0.05 to 1.56) were identified as moderators.

Conclusion

MSE significantly improved older adults' depression. The findings highlighted the importance of intervention frequency and retention rate in enhancing MSE effectiveness. More high quality RCTs are required to explore and optimize the intervention strategies and dosages of MSE to extend the application in the prevention and treatment of geriatric depression.

Impact of a multicomponent physical exercise program on intrinsic capacity in community-dwelling older adults

Introduction

In 2015, the World Health Organization introduced intrinsic capacity, a health indicator encompassing five domains aimed at promoting healthy aging. Multicomponent exercise programs are recommended to maintain and optimize intrinsic capacity; however, evidence on their effects in robust older adults is limited. This study aimed to evaluate the effects of a multicomponent exercise program on intrinsic capacity in older adults.

Methods

Older adults (≥60 years) enrolled in a multicomponent training program in Porto Alegre (RS) were evaluated for intrinsic capacity using specific tests for each domain. The total score, ranging from 0 to 10 points, was obtained by summing the scores of the five domains. Participants underwent a 12-week multicomponent exercise intervention and were reassessed.

Results

After the 12-week intervention, the composite intrinsic capacity score significantly increased. Significant improvements were found in the cognitive, vitality and locomotion domains. The practice of Chinese curative gymnastics contributed to a one-point increase in the composite intrinsic capacity score. No association was found between frequency, duration of training, or the number of exercise modalities and the composite intrinsic capacity score.

Conclusion

The multicomponent exercise program positively influenced composite intrinsic capacity, with notable improvements in vitality, cognition, and mobility. Personalization and individualization of training, combined with health education and social integration, were crucial in promoting healthy aging in the studied sample.

[Impact of APA on functional performance in elderly sarcopenic patients]

Adapted physical activity (APA) is an important means of preventing sarcopenia. Our aim was to evaluate the impact on functional performance of a multi-component program entitled "circuit gym", including the use of muscle-strengthening machines specially designed for seniors. This was a single-center interventional study combining endurance, machine resistance and balance exercises, lasting three months. We included 95 patients (mean age 82.5 years, 59% women). A median increase of two points in the Short Physical Performance Battery was observed at the end of the program (p<0.0001), as well as a significant improvement in walking speed, chair raising and Timed Up and Go. This study demonstrated a functional improvement in elderly sarcopenic individuals at three months associated with multicomponent adapted physical activity.

tDCS Combined with CIMT for Post-stroke Upper Extremity Rehabilitation: A Systematic Review and Meta-Analysis

BackgroundTranscranial direct current stimulation (tDCS) has been widely used as an adjunctive treatment for motor function after stroke.ObjectiveTo quantify the effect of tDCS combined with constraint-induced movement therapy (CIMT) on the functional recovery of the upper limb after stroke.MethodsBy May 2024, two independent authors screened relevant randomized controlled trials (RCTs) published in English from PubMed, Embase, Web of Science and the Cochrane Library. Publication bias was assessed using the Egger's test.ResultsOf the 221 retrieved records, seven publications met the criteria for systematic review and quantitative analysis. According to estimates of Hedges'g, significant effects were revealed from Fugl-Meyer Assessment for Upper Limbs (UL-FMA) for upper limb impairment (g = 0.587, 95% CI = 0.256 to 0.919, p < 0.05) and Motor Activity Log-Amount of Movement (MAL-AoM) for perceived amount of motor (g = 0.386, 95% CI = 0.030 to 0.743, p < 0.05). Significant results favoring combined therapy were not found in Motor Activity Log-Quality of Movement (MAL-QoM) (g = 0.181, 95% CI = -0.169 to 0.531, p > 0.05), grip strength (g = 0.135, 95% CI = -0.214 to 0.485, p > 0.05) or Wolf Motor Function Test (WMFT) (g = 0.210, 95% CI = -0.117 to 0.537, p > 0.05).ConclusionsOur findings confirmed that tDCS enhanced the effect of CIMT in improving upper limb impairment and perceived amount of motor in daily life after stroke.

Prediction of cognitive impairment among Medicare beneficiaries using a machine learning approach

OBJECTIVE

Developing machine learning (ML) models to predict cognitive impairment among Medicare beneficiaries in the United States.

METHODS

This retrospective study used the 2016-2019 Medicare Current Beneficiary Survey Cost and Use and Survey Public Use Files. Medicare beneficiaries aged 65 and older (n=4,965) with at least two consecutive years' data were included. Cognitive impairment was categorized into three stages: severe, moderate, and none based on self-reported data. Baseline year's demographic, socioeconomic factors, self-reported functional limitations, health status and comorbidities, number of concurrent medications, level of social engagement, behavioral variables, and satisfaction of medical care's quality were features assessed in ML algorithms to predict next years' cognitive function. ML models in six major categories were developed, tested, and compared (accuracy, AUC, and F1 score) using Python version 3.11. The importance of features was evaluated using the total reduction of the Gini. A subgroup analysis was conducted among beneficiaries who were 80 years and older.

RESULTS

Approximately 11.1% of beneficiaries aged ≥ 65 had moderate or severe cognitive function impairment. Baseline cognitive function was the most significant predictor for next year's cognitive function impairment, followed by baseline IADL, level of social activities, ADL, general health status, income, age, education, region of residence, and body mass index. Beneficiaries 80 years and older had satisfaction of medical care's quality among the top 10 most significant predictors.

CONCLUSIONS

Older adults' baseline cognitive function and IADL were top two predictors of cognitive function impairment. Clinicians should regularly screen and monitor older adults' cognitive and daily function.

Modulating effects of fitness and physical activity on Alzheimer's disease: Implications from a six-month randomized controlled sports intervention

BACKGROUND

Physical activity and fitness are major targets in Alzheimer's disease (AD) preventive research. However, current research is heterogeneous and often disregards the relationship between these parameters and disease outcomes.

OBJECTIVE

To assess the effects of physical activity and fitness on AD within the context of a multicomponent sports intervention.

METHODS

46 participants with early-stage AD (mean age 70 ± 7 years, 18 women, mean Montreal Cognitive Assessment (MoCA) score 19±5) were included in a six-month randomized controlled trial (Dementia-MOVE), participating in either a multicomponent sports intervention or a control condition with a psychoeducational program. The modulating effect of fitness and physical activity changes on AD outcome parameters such as cognition, function and cerebral brain structure from 3T-MRI were examined using multiple linear regression analyses.

RESULTS

An increase in VO2max was associated with assignment to the intervention group (p = 0.016), lower baseline fitness (p = 0.001), and an increased rate of physical activity (p = 0.046). Only in the intervention group, ΔVO2max had a beneficial modulating effect on the MoCA score (p = 0.039), the executive functions (p = 0.017) and regional brain volumes of the temporal lobe, e.g., the hippocampus (p = 0.044). High daily step count was associated with preserved executive functions (p = 0.001), and caregivers' quality of life (p ≤ 0.001) in the overall sample.

CONCLUSIONS

Our results confirm that multicomponent exercise improves cardiorespiratory fitness in AD, which is associated with advantageous developments in cognitive performance and preservation of brain structure. These findings suggest that especially patients with comparably worse cognition and fitness benefit and should be encouraged for activity engagement.

Effects of exercise on patients with vascular cognitive impairment based on ACSM recommendations: a systematic review of randomized controlled trials

BACKGROUND

Exercise is considered to be an effective method for functional recovery in patients with vascular cognitive impairment (VCI), but there is a paucity of research on exercise dosage. There has been no meta-analysis of the effects of exercise therapy for vascular cognitive impairment based on the American College of Sports Medicine (ACSM) exercise prescription for a seemingly healthy population. We therefore conducted a study to analyze the effects of various exercise therapies on cognitive functioning, physical functioning, and ability to perform activities of daily living in patients diagnosed with vascular cognitive impairment.

METHODS

Four electronic databases, namely PubMed, Embase, Web of Science, and Cochrane, were systematically searched for studies examining the effects of exercise on patients with VCI. The exercise interventions were categorized into an ACSM high adherence group versus an ACSM low or indeterminate adherence group, following the recommendations for exercise testing and prescribing for seemingly healthy populations developed by ACSM. Meta-analyses were conducted using a random effects model to compare results among subgroups.

RESULTS

The study encompassed 14 trials involving 1333 subjects. Among these, 8 studies adhered highly to ACSM recommendations, while 6 studies demonstrated low or uncertain adherence. Subgroup analyses revealed differing effects: in the high adherence group, SMDs for cognitive functioning, living ability, and physical functioning were 0.53 (95% CI 0.13-0.94), 0.53 (95% CI 0.11-0.94), and 0.66 (95% CI 0.45-0.87), respectively. Conversely, in the low or indeterminate adherence group, SMDs for cognitive functioning, living ability, and physical functioning were 0.09 (95% CI - 0.13 to 0.32), - 0.11 (95% CI - 0.57 to 0.34), and 0.65 (95% CI - 0.04 to 1.35). We performed subgroup analyses by type of vascular cognitive impairment, and meta-analyses showed positive SMDs of 0.59 (95% CI 0.22-0.97) and 0.68 (95% CI 0.47-0.90) for exercise on cognitive impairment after stroke in terms of cognitive function and physical function, respectively.

CONCLUSION

The results suggest that exercise interventions exhibiting high adherence to ACSM guidelines yield more favorable outcomes concerning cognitive functioning, physical functioning, and daily living abilities among patients with VCI compared to interventions with low or uncertain adherence to ACSM recommendations.

The effectiveness of multicomponent exercise in older adults with cognitive frailty: a systematic review and meta-analysis

BACKGROUND

Cognitive frailty, intimately tied to adverse outcomes such as falls, early mortality, and hospitalization, represents a dynamic, reversible process. Multicomponent exercise has emerged as one of the most potent means of mitigating cognitive frailty.

AIMS

This research seeks to quantitively amalgamate the effects of multicomponent exercise on various domains: cognitive function, frailty status, and other health-related outcomes in cognitively frail older adults.

METHODS

Our methodology entailed a comprehensive review of literature in databases including PubMed, EMbase, CINAHL, Cochrane Library, Web of Science, Wanfang, Sinomed, VIP, and CNKI from the inception of these databases to December 10, 2023. For our statistical analysis, we utilized RevMan 5.3, Stata 17.0 and R 4.3.2 software. Adherence was maintained to the PRISMA checklist, with the study being registered with PROSPERO (CRD42024499808).

RESULTS

Our review encapsulated a total of 2,222 participants and 11 trials. The findings intimate that multicomponent exercise enhances cognitive function [MD = 2.52, p = 0.03]), grip strength[SMD = 0.39, p = 0.008] and lower limb muscle strength[MD = 4.30, p < 0.001], while alleviating frailty[MD = -2.21, p < 0.001] and depression [MD = -1.20, p = 0.001]. However, cogent evidence is still lacking to endorse the positive effects of multicomponent exercises on both ADL(p = 0.19) and quality of life(p = 0.16). Subgroup analyses revealed beneficial effects on cognitive frailty for multicomponent exercise whose type of exercise consisted of aerobic, the duration of which exceeded 120 min per week, and whose form of exercise was group exercise.

CONCLUSION

Multicomponent exercises offer significant improvements in cognitive function, muscle strength, and have the added benefit of reducing frailty and depression in older adults. However, these exercises do not appear to influence activities of daily living and quality of life positively.

The Effectiveness of Motor Imagery in Balance and Functional Status of Older People with Early-Stage Dementia

BACKGROUND/OBJECTIVES

Dementia involves the loss of cognitive abilities and impairs functional abilities in daily life. In motor imagery (MI) techniques, motor acts are mentally rehearsed without any overt body movements. The purpose of the randomized controlled trial was to examine the effects of MI on the motor function of older adults with dementia.

METHODS

Overall, 160 participants (43 men, 117 women, MMSE M = 23.20, SD = 0.15) from an Athens Day Care Center of the Alzheimer Association were randomized to (a) the MI and exercise group (experimental group) (n = 55), (b) the only exercise group (1st control group) (n = 52) and (c) the neither MI nor exercise group (2nd control group) (n = 53). The exercise session comprised 24 physiotherapy exercise sessions, lasting 45 min each, twice a week for 12 weeks. The exercises were selected from the Otago Exercise Program. Three assessments were performed: (a) one week prior to the program, (b) at one and a half months and (c) after the program. The experimental group performed a 30-minute MI with exercise program content after the end of every physiotherapy exercise session. The Multidirectional Reach Test, Five Times Sit-to-Stand Test (FTSST), Timed Up and Go test (TUG), Functional Gait Assessment (FGA) and Berg Balance Scale (BBS) were used to assess participants' balance and functional status.

RESULTS

In the intention to treat analysis (18 participants dropped out), the 3 × 3 repeated measures ANOVA indicated statistically significant results between the three groups on (a) the TUG (F = 3.06, df (2), p = 0.04), (b) the FTSST (F = 3.00, df (2), p = 0.05), (c) the forward direction test (F = 4.14 df (2), p = 0.02), the lateral right and the lateral left direction tests (F = 3.90, df (2), p = 0.02 and F = 7.87, df (2), p = 0.00, respectively), and (d) the FGA (F = 4.35, df (2), p = 0.01). The Friedman test showed significant statistical significant differences among the three groups for BBS (X2 = 7.62, df = 2, p = 0.22), and an effect size of partial η2 coefficient for F-tests was found. Post hoc comparisons using a Bonferroni test for ANOVA and Wilcoxon test for Friedman indicated that the mean scores for the experimental group and the 1st control were significantly better than the 2rd control group in many dependent variables.

CONCLUSIONS

The study showed a positive effect of MI on balance and the functional status of older adults with early stages of dementia with possible beneficial effects on maintaining independence and reducing physical decline.

Methods to characterize lactate turnover in aging and Alzheimer's disease; The LEAN study

BACKGROUND

There is evidence that chronic exercise can benefit the brain, but the effects vary markedly between studies. One potential mechanism for exercise-related benefit is the increase in systemic lactate concentration that is well-characterized to occur during exercise. Lactate is known to cross the blood brain barrier and can be used readily as a fuel for neurons. This may be particularly important in Alzheimer's Disease, which is characterized by cerebral hypometabolism. However, little is known about how whole-body lactate metabolism differs between older adults and individuals with cognitive impairment. This information is critical when considering potential differences in responses to exercise in various cognitive diagnosis groups.

METHODS

Here we describe the use of a "lactate clamp" procedure to adjust blood lactate levels to approximate those achieved during exercise, but while at rest. This trial will compare lactate oxidation between cognitively healthy older adults and cognitively impaired participants. We will further evaluate the effect of acute lactate infusion on cognitive performance.

DISCUSSION

The findings of the study described here, the Lactate for Energy and Neurocognition trial (clinicaltrials.gov # NCT05207397) will add to our understanding of systemic lactate mechanics in cognitively healthy older adults and individuals with Alzheimer's Disease. These findings will be applicable to ongoing exercise trials and to future studies aimed at modulating systemic bioenergetic function in aging and Alzheimer's Disease.

[PAPPS update on older people 2024]

Population aging is a global phenomenon that is increasing the proportion of older people, particularly those over 80 years old. This increase in longevity does not always translate into years of good quality of life. This document reviews the latest evidence on the main preventive activities for older adults, starting with major geriatric syndromes such as frailty, cognitive impairment, and social isolation. It evaluates direct interventions in nutrition, deprescription, and physical exercise. Additionally, for the first time, it includes an analysis of preventive activities related to suicide in older adults, coordinated with mental health promotion programs. Frailty, defined as the progressive deterioration of physiological systems, is a significant predictor of adverse health events and is considered potentially reversible, especially in its early stages. The diagnosis and management of frailty through comprehensive geriatric assessment (CGA) and the implementation of specific interventions such as multicomponent exercise, adequate nutrition, and medication review are key to improving the functionality and quality of life of older adults.

Effects of multicomponent exercise on cognitive function in persons with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Multicomponent exercise has the potential to improve cognitive function in people with mild cognitive impairment. However, the effects of multicomponent exercise on specific cognitive subdomains in mild cognitive impairment and the optimal combination of exercise components remain unclear.

OBJECTIVE

This systematic review aimed to (a) investigate the effects of multicomponent exercise on different cognitive subdomains in people with mild cognitive impairment and (b) investigate the effects of different combinations of multicomponent exercise on global cognition in people with mild cognitive impairment.

DESIGN

A systematic review and meta-analysis.

METHODS

Six electronic databases, including PubMed, Medline, EMBASE, Web of Science, Cochrane Library, and CINAHL were systematically searched from inception to January 1st, 2023. Randomized controlled trials assessing the effect of multicomponent exercise interventions on cognitive function in people with mild cognitive impairment were included. The risk of bias was assessed using the Cochrane collaborative bias assessment tool. A random-effects model was used to calculate standardized mean difference. Subgroup analyses, meta-regression, and sensitive analysis were performed. If a meta-analysis was not feasible, studies were synthesized narratively.

RESULTS

Twenty studies were identified for systematic review and meta-analysis. Multicomponent exercise significantly improved global cognition [SMD = 1.04; 95 % confidence interval (CI): 0.53, 1.55], cognitive flexibility (SMD = -1.04; 95 % CI: -1.81, -0.27), processing speed (SMD = 0.43; 95 % CI: 0.04, 0.82), verbal fluency (SMD = 0.38; 95 % CI: 0.13, 0.63), attention (SMD = -0.90; 95 % CI: -1.68, -0.12) and memory (SMD = 0.36; 95 % CI: 0.04, 0.69) in mild cognitive impairment. The multicomponent exercise including cardiovascular (exercise that promotes cardiovascular health, such as endurance training or aerobic exercise) and motor (exercises that improve physical abilities, such as balance, coordination, agility, flexibility, etc.) components positively affected global cognition in people with mild cognitive impairment (SMD = 1.06; 95 % CI: 0.55, 1.57).

CONCLUSIONS

The findings of this study suggest that multicomponent exercise has a positive impact on various cognitive domains, including global cognition, cognitive flexibility, processing speed, verbal fluency, attention and memory in mild cognitive impairment. Specifically, the combination of exercises including cardiovascular and motor components was found to be effective in improving global cognition. However, further research is needed to investigate the optimal frequency and intensity of the multicomponent exercise intervention, and more detail about exercise combinations of the motor component (not classified in this study) for individuals with mild cognitive impairment.

REGISTRATION

The protocol was registered on PROSPERO (CRD42023400302).

Acute exercise alters brain glucose metabolism in aging and Alzheimer's disease

There is evidence that aerobic exercise improves brain health. Benefits may be modulated by acute physiological responses to exercise, but this has not been well characterized in older or cognitively impaired adults. The randomized controlled trial 'AEROBIC' (NCT04299308) enrolled 60 older adults who were cognitively healthy (n = 30) or cognitively impaired (n = 30) to characterize the acute brain responses to moderate [45-55% heart rate reserve (HRR)] and higher (65-75% HRR) intensity acute exercise. Each participant received two fluorodeoxyglucose positron emission tomography (FDG-PET) scans, one at rest and one following acute exercise. Change in cerebral glucose metabolism from rest to exercise was the primary outcome. Blood biomarker responses were also characterized as secondary outcomes. Whole grey matter FDG-PET standardized uptake value ratio (SUVR) differed between exercise (1.045 ± 0.082) and rest (0.985 ± 0.077) across subjects [Diff = -0.060, t(58) = 13.8, P < 0.001] regardless of diagnosis. Exercise increased lactate area under the curve (AUC) [F(1,56) = 161.99, P < 0.001] more in the higher intensity group [mean difference (MD) = 97.0 ± 50.8] than the moderate intensity group (MD = 40.3 ± 27.5; t = -5.252, P < 0.001). Change in lactate AUC and FDG-PET SUVR correlated significantly (R2 = 0.179, P < 0.001). Acute exercise decreased whole grey matter cerebral glucose metabolism. This effect tracked with the systemic lactate response, suggesting that lactate may serve as a key brain fuel during exercise. Direct measurements of brain lactate metabolism in response to exercise are warranted. KEY POINTS: Acute exercise is associated with a drop in global brain glucose metabolism in both cognitively healthy older adults and those with Alzheimer's disease. Blood lactate levels increase following acute exercise. Change in brain metabolism tracks with blood lactate, suggesting it may be an important brain fuel. Acute exercise stimulates changes in brain-derived neurotrophic factor and other blood biomarkers.

Sleep duration and leisure activities are involved in regulating the association of depressive symptoms, muscle strength, physical function and mild cognitive impairment

Background

In order to lessen the burden of Alzheimer's disease (AD), timely and efficient management and intervention methods for mild cognitive impairment (MCI) are crucial. MCI is seen as a transitional stage between normal aging and dementia. Although sarcopenia is an important risk factor for MCI, it is unclear what factors mediates and regulates the brain-muscle communication. Our objective was to investigate the indirect moderating effects of sleep duration and leisure activity on depressive symptoms, sarcopenia and MCI.

Method

Panel data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) database was used in this investigation. we used Bootstrap sampling to determine the relationship between sleep duration, leisure activity, depressive symptoms, sarcopenia, and MCI in mediation and indirect moderation models. The outcome measurements were odds ratio (OR) and confidence interval (CI).

Result

After adjusting for confounding variables, we discovered that sarcopenia and its traits, such as handgrip strength, gait speed, standing test, and muscle mass, were significantly correlated with MCI. Second, the results implied that depressive symptoms played a role in modulating the link between physical function, muscle strength, and MCI. This moderating effect was impacted by short sleep duration and moderate to high levels of leisure activities.

Conclusion

We discovered that MCI was highly correlated not only with physical function and muscle strength but also with depressed symptoms, which acted as a partially mediating factor in this connection. Handgrip strength, gait speed, and standing test mediated the correction of MCI caused by depression symptoms. Importantly, leisure activities and sleep duration had indirect moderating effects on the above associations, and future management policies should take these factors into account.

The Sound of Memory: Investigating Music Therapy's Cognitive Benefits in Patients with Dementia-A Network Meta-Analysis of Randomized Controlled Trials

Numerous previous studies have shown the effectiveness of music therapy in enhancing cognitive functions in patients with dementia. Despite this, robust evidence in this field, especially concerning the comparison of different music therapy types, is lacking. Therefore, randomized controlled trials (RCTs) focusing on music therapy and cognitive functions in dementia patients, termed by "music" AND "dementia" OR "Alzheimer's disease" AND "cognitive", were identified from primary electronic databases to conduct this network meta-analysis (NMA). The primary outcome focused on the impact on cognitive functions, and the secondary outcome was the comparison of dropout rates between the intervention groups and the usual care control groups. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed for effect evaluation. This study protocol has been registered in IPLASY (INPLASY202430082). A total of 14 RCTs with 1056 participants were enrolled, examining interventions including Active Music Therapy (AMT), Active Music Therapy with Singing (AMT + Sing), Rhythmic Music Therapy (RMT), Listening to Music (LtM), and Singing (Sing). The results indicated that RMT, AMT + Sing, and AMT all significantly improve cognitive functions in dementia patients, of which the SMD were 0.76 (95% CI = 0.32-1.21), 0.79 (95% CI = 0.03-1.49), and 0.57 (0.18-0.96), respectively. Compared with the control group (usual care), no music therapy type was associated with an increased dropout risk. In conclusion, music therapy can improve cognitive functions in patients with dementia without increasing the risk of dropout, particularly RMT, AMT + Sing, and AMT.

Effects of Multicomponent Exercise on Community-Dwelling Older Adults With Mild Cognitive Impairment

PURPOSE

To explore the effects of a group-based multicomponent exercise program on general cognitive functioning, depression, and social functioning in community-dwelling older adults with mild cognitive impairment (MCI) and whether the effects can be maintained.

METHOD

Fifty older adults with MCI were conveniently recruited from two communities in the study area and randomly assigned to the intervention group or control group. The intervention group received three sessions of 60-minute, multicomponent exercise per week for 3 months, plus MCI-related health education. The control group only received MCI-related health education. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Beijing Version (MoCA-BJ) were used to assess general cognitive function. The Functional Activities Questionnaire (FAQ) and Geriatric Depression Scale (GDS-30) were used to evaluate participants' social function and depression, respectively. Participants' exercise intensity was assessed using the Category Ratio Scale.

RESULTS

After the 3-month intervention, there were significant improvements in general cognitive function (p = 0.046), attention (p = 0.009), delayed recall (p = 0.015), and social function (p = 0.011) in the intervention group compared with the control group. However, after 3-month postintervention follow up, no significant differences in MMSE, MoCA-BJ, GDS-30, and FAQ scores were noted between groups.

CONCLUSION

The 3-month multicomponent exercise program improved general cognitive function and social functioning in community-dwelling older adults with MCI. However, there was no evidence that these benefits lasted for another 3 months after stopping the exercise program. [Research in Gerontological Nursing, 17(2), 65-79.].

Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health

INTRODUCTION

The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI.

AREAS COVERED

The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They emphasize modifiable risk factors identified by the 2020 Lancet Dementia Commission. The most profound risks for VCI also include lower education, cardiometabolic factors, and compromised cognitive reserve. Finally, they discuss pharmacological and non-pharmacological interventions.

EXPERT OPINION

By virtue of the high frequencies of stroke and cardiovascular disease the global prevalence of VCI is expectedly higher than prevalent neurodegenerative disorders causing dementia. Since ~ 90% of the global burden of stroke can be attributed to modifiable risk factors, a formidable opportunity arises to reduce the burden of not only stroke but VCI outcomes including progression from mild to the major in form of vascular dementia. Strict control of vascular risk factors and secondary prevention of cerebrovascular disease via pharmacological interventions will impact on burden of VCI. Non-pharmacological measures by adopting healthy diets and encouraging physical and cognitive activities and urging multidomain approaches are important for prevention of VCI and preservation of vascular brain health.

Effect of a multicomponent programme based on reality orientation therapy on the physical performance and cognitive function of elderly community-dwellers: a quasi-experimental study

BACKGROUND

Effects of a multicomponent exercise programme have an impact on the physical, cognitive, and psychological domains in elderly community-dwellers. However, some individuals aged 65 years or more have not shown positive effects after the intervention as reported in similar research. The objective of this quasi-experimental study was to clarify the effectiveness of a multicomponent programme based on reality orientation therapy (ROT) on the physical performance, cognitive ability, and psychological state in the elderly.

METHOD

Participants were recruited from the general public in 20 areas of Akita Prefecture, Japan, and they took part in each exercise programme for 90 min a day, once every 2 weeks, for 3 months, according to the group classification using cluster randomization into 20 cohorts in Akita. Physical, cognitive, and geriatric depression assessments were performed at baseline and after the 3-month intervention in both the ROT-based intervention group and the control group.

RESULT

The final samples for analysis consisted of 31 participants in the control group and 30 participants in the intervention group. The results of the statistical analysis comparing the two groups showed that the 5-repetition sit-to-stand test was performed significantly faster (P < 0.05) and that the results of the word list memory (WM) test and the Symbol Digit Substitution Task also had significantly improved (P < 0.05) after the intervention in both groups. The WM score did not show an interactive effect between the group and time factors, but it had a significant main effect on time in both groups (P < 0.05).

CONCLUSION

The results of our quasi-experimental study indicated that the multicomponent programme based on the ROT would be as effective as the original multicomponent programme combined with aerobic exercise and cognitive tasks, as highlighted in the WM.